Even though older adults tend to say they prefer to avoid aggressive treatment as they approach the end of life, 50% of them end up in the emergency department in the last month of their life, with a third being admitted to an intensive care unit, Karen Lasater told the Penn 2018 Health Policy Retreat.

"I'm curious to understand why it is that in the most resourced of all our health care settings -- hospitals -- older adults don't get the kind of care they want," said the Penn School of Nursing Assistant Professor and LDI Senior Fellow.

Lasater, PhD, RN, is part of a team that has been asking hospital nurses what they think about the end-of-life care in their own facilities.

Half of those nurses say their patients experience painful or uncomfortable procedures not likely to change their outcomes.

Two-thirds of the nurses say they often disagree with their physician colleagues about end-of-life care decision making -- indicating serious dissension in care teams.

And only 15% of the nurses rate their own hospital's end-of-life care as "excellent."

"Advancing improvement in end-of-life care is a difficult challenge," said Lasater. "It will require attention and modifications to the nurse work environment and to how frontline providers are interacting with patients as well as their colleagues."